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                                                                                                                                        Uso Oficial

                                  1st International Workshop on HCG and Obesity
                                        Buenos Aires – September 23-26, 2004
                                                 Deadline for reservations: August 23, 2004
                                                                                  PARTICIPANT                (PLEASE TYPE OR PRINT IN CAPITAL LETTERS)

First Name                                                                            Last Name
Street Address                                                                        City
Province/State                                           ZIP Code                                                 Country
Fax (      )                                                                          Phone (           )
                                                                      RESERVATION PROCEDURES
Deposit: In order to confirm a reservation, a two-night deposit is required for each hotel room requested. It may be charged to a credit card (Visa,
MasterCard, or American Express), or sent it by bank transfer to the Hotel & Tourism bank account (please consult us for this information). Please note
that the deadline for bank transfers is August 23rd, 2004. After this date no more requests paid by bank transfers will be accepted.
Balance: The balance of the hotel as well as all additional charges shall be paid directly to the hotel.
Cancellations: Full refund less US$20 administrative charge will be granted for cancellations received until August 23 rd, 2004. For cancellations received
after August 24th, 2004 and no-show(s) will have a charge equivalent to a one night rate. All cancellations or changes must be in writing to the General
                                                                      HOTEL CATEGORY SELECTION
Please complete:

              Hotel                   Single US$         Double US$        Check-in date           Check-out date # of rooms Deposit per room                              Subtotal US$
   5 Caesar Park Hotel                  155.00                155.00                                                              155.00
   4 Loi Suites Recoleta                 95.00                 95.00                                                               95.00
                                                                                                                                     Total US$
                                                                                     
                                                                                                                            (To guarantee, (an) additional night/s has/have to be
   I wish to guarantee:                          Early check-in                                Late check-out               paid.)

   Room type:                                   Single                                       Double / 1 bed                      Double / 2 beds 

                                                Smoking                                      Non-Smoking                          Disabled (Please specify any special requests)

The published rates are quoted in US dollars, on a nightly basis. VAT IS NOT INCLUDED (currently 21%). Reservations will be handled on a first-come,
first-serve basis. Confirmation of the reservation will be sent to you in due course, including the hotel assigned and its information. Check-in time: 15:00
hrs. Check-out time: 12:00 hrs.

IMPORTANT: this portion must be filled out completely. Requests for reservation without complete payment information will not be processed and
confirmed. If Credit Card Security Code (or bank transfer slip) is not provided hotel reservation will not be confirmed.

  I include a copy of the bank deposit receipt (If this copy is not attached the reservation will not be processed)
  Credit Card, please mark:                                 Visa (VI)                      MasterCard (MC)                American Express (AX)
                                                              (13 to 16 digits)                (16 digits)                         (15 digits)

 I hereby authorize the designated hotel to debit from my credit card account the total amount of the required deposit.

 Card Number:                                                                                                                             Exp. Date:                    /
                       1      2    3     4       5        6       7     8         9    10     11   12        13   14   15     16                             Month            Year

 Cardholder’s Name                                                                                                           Security Code:
 Name as it appears on card                                                                                                  VI / MC: final three digits on reverse side of the card
                                                                                                                             AX: final four digits on front of the card (upper level)
 Date                                                             Signature:
                                                         I HEREWITH ACCEPT THE CONDITIONS STATED IN THIS FORM

               Please return this form to: Congresos Internacionales S.A. Lima 355 – PB B – C1073AAG Buenos Aires - Argentina
    Tel: (54.11) 4382 5772 Fax: (54.11) 4382 5730 - E-mail: - E.V.T.(Travel Agency) – Leg. Nº 7526 Res. 97/93

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